HeadWise HeadWise: Volume 6, Issue

“ Patients need to be aware that there are plenty of medical and surgical options available and not to become discouraged.”

the transmission of pain. One patient with non-responsive pain due to surgical injury of the great auricular nerve after parotid tumor resection, reported burning electric shock-like sensations in the region of the scar that could be provoked by wind or light touch. The patient was treated with various drugs such as pregabalin, gabapentin, carbamazepine, oxcarbazepine, amitriptyline, and duloxetine – in singular therapy and in combination. The patient was pre-treated with lidocaine cream 4 % for 60 minutes. With the application of the capsaicin 8 % patch for 60 minutes in the location of the pain, his pain decreased within 12 hours. The decrease in pain lasted 8 to 12weeks and the treatment was repeated four times with the same effect.

Orofacial pain includes pain within the oral cavity( mouth). Often, patients are referred to specialized headache centers when in reality their pain stems from an intraoral cause. Rare disorders such as pulpitis( inflammation of the pulp of a tooth), cracked tooth syndrome, burning mouth syndrome, and atypical toothache are some of the rare causes of dental pain. Due to the significant nerve convergence in the jaw and face, the pain may be referred, poorly localized, or misdiagnosed. Dental pulp and periodontal ligaments contain nociceptors( pain receptors) which are triggered by pressure in response to inflammatory mediators. Pulpitis is typically due to dental caries( destruction or death of a tooth) and may be reversible in response to specific stimuli such as hot, cold, or sweets. The pain may be described as fleeting, shooting, or stabbing. Cracked tooth syndrome occurs when a crack has occurred in the dental hard tissues and reaches the pulp chamber but the crack is not visible to the naked eye. The pain is intermittent, provoked by biting or releasing biting on a hard object, and notoriously difficult to diagnose. It may be described as sharp or sensitive and is usually related to chewing.

Burning mouth syndrome is a collection of symptoms affecting the oral cavity described as a“ burning” pain in the mouth associated with an alteration in taste and altered perception in the quality and quantity of saliva. The symptoms are most commonly localized to the tongue, and is most commonly seen in peri-menopausal or postmenopausal females. It is strongly associated with psychological conditions, such as anxiety and depression, and the symptoms are typically worsened during periods of psychological stress.

Cranial neuralgias and other facial pains can wear many different disguises, making them very difficult to diagnose and treat. Even when the appropriate diagnosis is established, there is often a mismatch between patient’ s expectations of a“ cure” for their pain and the reality that many of these neuralgic pains may become chronic. Many of these sufferers have been passed along from physician to physician without answers, leaving them to feel abandoned or neglected. Many of the symptoms are difficult for patients to describe. Shephard et al suggests that health care practitioners should not be“ taking” a history but“ receiving” it. In other words, a physician’ s concern is to translate the subjective experience of illness into the recognizable discourse of medicine. Patients need to be aware that there are plenty of medical and surgical options available and not to become discouraged. It is imperative that physicians are sensitive, especially to patients suffering from painful cranial neuralgias and other facial pains. HW

HeadWise HeadWise: Volume 6, Issue | Page 17